It used to be that the kidneys or liver you were born with were the only ones you could reasonably expect to have a stake in. Giving someone your heart was purely metaphorical. But now that organ transplants are part of the medical repertoire, we also need to decide where they fit in the economy. When you give part of your body to someone else, is it a gift or a sale?
In a recent issue of Transplant International, researchers Klaus Hoeyer and Ida Deleuran from the University of Copenhagen, along with Silke Schicktanz from Germany’s University Medical Center Goettingen assessed public attitudes to financial incentives for organ donors.
The researchers compiled 23 studies conducted in Argentina, Austria, Brazil, Cyprus, Egypt, France, Germany, Great Britain, India, Iran, The Netherlands, Pakistan, the Philippines, Qatar, Switzerland, Sweden, and the United States. Needless to say, policy differs wildly in different countries, as does the availability of organs on the black market. In the U.S., residents of 16 states currently get tax deductions of up to $10,000 for offering up an organ. In 2012, the World Health Organization reported that an organ was sold on the black market every hour, many from countries such as India, where people with nothing else left to sell will often undergo organ removal at a low price and in dangerous conditions.
There’s an obvious reason why offering cash for organs makes sense: waiting lists are long, and many people die while they’re hoping for someone else’s altruism to kick in. Living donation (when you undergo an operation to have one of your organs removed) is painful and can be dangerous, and recovery can be slow. Deceased donation, when you sign the line on your driver’s license or health card expressing your wish to have your usable organs harvested when you die, arouses all our oldest fears and taboos around the sanctity of the dead. In other words, organ donation is a tough sell.
So governments and health professionals are constantly trying to figure out how to convince people to donate. Hoeyer et al.’s study comes in the context of a wave of recent interest in trying to devise systems to incentivize organ donation, and there is a lot of disagreement over whether money, in this case, talks.
For the most part, the current study finds, it doesn’t. In all of the studies they surveyed, support for donors receiving cash was at 30 percent or lower. In studies that offered participants the chance to give qualitative feedback, some commented that cash for organs was “immoral” or “unnatural.” The preference was for purely altruistic reasons for donating organs. There was a slightly more positive attitude towards offering financial incentives in the U.S. studies as compared with a very low approval of this in Germany, Austria, Switzerland, and the Netherlands, with Britain and Scotland falling somewhere in between.
It was, however, acceptable to some that, in the case of deceased donation, the organ recipient and their family might cover the funeral costs of the donor. And most agreed that donors shouldn’t have to pay their own hospital costs, although respondents often said they thought the government should pay for hospital time, rather than the donor or the recipient.
The researchers also noted that in many cases, getting an organ from someone without having any way to formalize the experience—as a cash exchange would—has its own tricky economics: “Focus groups with living donors and recipients highlight how nonremunerated organ transfers create a strong sense of obligation and debt on behalf of the recipient.” In some cases, this sense of a debt that can never truly be repaid can become a burden on organ recipients. Hoeyer et al. refer to this never-ending obligation as “the tyranny of the gift,” a term coined in the ‘90s by medical sociologists. Even within a family, receiving such an intimate gift from someone can make you feel guilty for the rest of your life.
It may be that rather than offering cash, there are simpler ways to increase the rate of organ donation. In Canada, we have a system that asks you to opt in to deceased donation—you sign up if you want to donate—but in many European countries, everyone is automatically considered a donor, and if you don’t want to be, you have to opt out.
It’s definitely gross and upsetting to think about. But at the same time, there’s something kind of neat about thinking that after you die, other people could be walking around with your kidney or your liver or your eyeballs. And if you never got around to doing any good deeds while you were alive, it’s nice to have one last chance to make up for it.
